Physical Exam One
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. What would you like to do?
What are some common types of assessment?
- Routine clinical checkup
- Periodic physical exam
- Subjective vs objective data
What type of assessment assesses symptoms restricted to a specific body system
What assessment takes alot of time.
What are the seven components of a Comprehensive adult history
- Identifying- Data and source of history
- Cheif Complaint
- Present illness
- Past History
- Familty History
- Personal or Social Hx
- Review of systems
Varies on pts memory trust and mood
Present illness (HOPI) does what an includes what
Amplifies C/C, describes development of symptoms, includes PTs thoughts about the illness and feelings.
What is tangential Lighting?
Lighting from an angle
What is perpendicular lighting
Straight down son!
Pediactric exams should allow for what type of otoscopy
Thick walled tubing should be _____cm to ____cm long.
30-38cm or 12-15in
What is used for two point discrimination?
Safety pin, Q-tips
Tuning forks should be between how many Hz?
128hz to 512 hz
Draping a patient is to...
visualize one area of the body at a time and preserve modesty
What inspection techniques should be used?
What is a bruit?
Turbulence over arterial vessels
Whysical exam principles
- Develop a systematic sequence of examination
- Maximize patients comfort
- Avoid unnecessary changes in position
- Enhance clinical efficiency
What do you check for in the heart
S3 and murmer of mitral stenosis
Quality of an Xray is based on...
- Skill of the xray taker
- Proper interpretation
What is needed in order to take an xray
- A source to produce the xrays
- A method to record
- A way to process the recorded image
What population are Xrays dangerous to?
What uses a rotating xray beam and multiple rotating detectors?
Data is collected from a CT scan producing multiple...
slices of 2D images
CT can be completed within ___ min
CT scans are best for...
Neuroimaging, abdominal and pelvic studies, soft tissues and checking for fractured organs
Ultrasound can see what
Images in real time and blood flowing through blood vessels
What is the equipment held to the skin that sets off high frequency sound waves?
The image of an ultrasound is based on what?
Frequency, strength (amplitude) of sound signal and the time it takes to return from the patient to the transducer
The area between the liver and the kidney is.
U/S has difficulty penetrating through...
Bone, gas filled structures
What is used to listen to the fetal heartbeat (U/S)?
Dopplar fetal heart rate monitor
Equipment needed for U/S
- Ultrasound machine
- Appropriate transducer
- Ultrasound Gel
MRI uses what to obtain images?
Strong magnetic fields and radio waves.
MRI is best for
soft tissue, tumor detection, spinal cord injuries, non iodine contrast agents
Scans with the MRI take how long?
MRI is _______________ in pregnant patients for ...
Contraindicated, some providers
CT and MRI are generally displayed in three planes or slices, they are
- Axial (horizontal) or transverse
Denser objects will have a _________ appearance on an Xray because it absorbs more xrays
Air appears as what color on an xray?
Fat shows up as ______ on an xray
These two have the same density on an Xray.
Fluids and soft tissue
Tissue contrast is determined on an MRI by...
How quickly the nuclei recover from radiowave stimulation
Five technicat factors to evaluate on a chest xray
During a CXR, you should be able to barely see the _______ through the heart
To check for proper inspiration in a CXR, how many ribs posterior ribs should be visible in a
Another way to determine a proper CXR is
5,6,7 anterior rib intersecting with the diaphragm at the MCL
When an xray beam is angled towards the head, the film obtained is an _________
apical lordotic view
For a lordotic view, the clavicle must be over the _____ rib
Two incomplete fractures are
Angle of a fractures is the relation of the ________ to the proximal
Shortening is measured in ____ when there is overlap
high frequency, electromagnetic ionizing rays
Inverse square law is
Double the distance decreases the effects by quadruple
Steps in clinical reasoning are
- ID abnormal findings
- Localize the findings anatomically
- Interpret and find probably process
- Make a hypothesis
Steps in finding a hypothesis are
- Select most specific and critical findings
- Math findings against any conditions that could produce em
- Eliminate diagnostic possibilities that fail to explain findings
- Weigh competing posibilities
- Give special attn to life threatening and treatable conditions
- Test hypothesis
- Develop working diagnosis
- Develop a plan
Statistical tools are
- Predictive value
Sensitivity in statistical data
ID the person who will test positive in a group of people who have the disease.
Good at picking up disease
ID people who test negative in a group without the disease
Indicates how well a given symptom or test will predict the prescense or abscense of a disease
How do you respond to emotional cues with a PT?
An interpreter should be seated...
next to the patient
CAGE for alcoholism is...
- Need to CUT DOWN
- Other people get ANNOYED
- Feelings of GUILT
Three dimensions for cultural awareness
- Respectful Communication
- Collaborative Partnerships
Building blocks of professional ethics are
The Tavistock principles
Vitals needed (basic)
- Blood Pressure
- Heart Rate
The width of a BP cuff should be ____ of the length of the upper arm.
The length of a BP cuff should be _____ of the arm _______
80% of the arm circumference
When taking BP use PT's _______ arm first
Caffiene and nicotine should be avoided for ____ min before a BP check
Inflate the cuff until the pulse disappears then add ____ mm Hg to the cuff
30 mm Hg
Listen for a BP with the stethoscope over the _____
If readings after measuring both arms are over 10 mm Hg then __________, if still different PT might have a _______
- repeat measurement,
- aortic dissection
White coat hypertension occurs in _____
You should _____
- 10-25% of pts
- Relax the PT and tried again later in the visit
Assess heart rate for____
One full minute
Any irregular heart rate rythms should be verified with a...
Hyperpyrexia is an ______ temperature
106 degrees DAMN!
A recurring shaking chill suggests an....
extreme rise in temp and possible systemic bacteria/virus
Feeling hot and sweaty accompanies
A falling temperature
Chronic pain lasts over ______
Idiopathic pain is
Pain with unknown cause
The four As of pain management are
- Activities of daily living
- Adverse effects
- Abberant drug related behaviors
A good BMI is between....
Patients over the age of 50 should be advised to take more...
Mobility in the skin is...
the easy with which a fold of skin moves
Turgor in skin is...
the resistance of the skin to deformity
Skin chafin in or under folds of skin
to fuse, grow or run together
Vellus hair is
short, fine, inconspicous and inpigmented hair
The smile line, or cheek line is the...
Functio laesa is
loss or disturbance of function
Basal cell carcinoma affects how much of the population?
and begins where?
Squamous cell carcinoma affects how much of the population? and occurs where?
- 16% of population
- occurs in upper layers of epidermis
Malignant melanoma affects how much of population? Occurs where?
- 4% affects with 80% of related deaths
The HARMM Model is
- History of melanoma
- Age over 50
- Regular dermatologist absent
- Mole change
A patch that is .5 to 1.5 cm that is uniformly pigmented is a _______ and over _____ with a diameter of 1.5cm can suggest ________
- cafe au-lait spot,
Erethimia on the cheeks of a child can be caused by
Psoriases is usually on the _____ surface
A herald lesion that spreads to the trunk and beyond may be
What is a burrow
a tunnel in the epidermis (5-15 mm), ends at vesicle
thickening of epidermis, roughening of skin
Mees lines in nails indicate?
Arsenic poisoning, leprosy, hodgekins disease
Terrys nails occur when
Liver disease, CHF, diabetes
What would you like to do?
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